Review of malpractice suits finds supervision and handoff problems especially common

Teamwork and communication breakdowns, especially problems involving trainee supervision and handoffs, are among the most common sources of errors resulting in medical malpractice claims, researchers report in the Oct. 22 Archives of Internal Medicine.

Hardeep Singh, MD, of the Baylor College of Medicine in Houston, Texas, and colleagues reviewed random malpractice cases at five American liability insurers. The cases were closed between 1984 and 2004. The review focused on four clinical categories: obstetric, surgical, missed and delayed diagnoses, and medication.

Of 889 cases reviewed, 240 (27%) involved trainees with at least a moderate role in the error, of which 87% involved residents. More than two thirds of the cases involved severe outcomes, including significant or major physical injury and death. The most prevalent specialty was obstetrics and gynecology. Common contributing factors to errors included judgment errors, failures of vigilance or memory, and lack of technical competence or knowledge. Teamwork errors played a role in 70% of the cases, with handoff errors and lack of supervision especially prevalent.

An accompanying editorial proposes a new model of collaborative, "translational" patient care that the editorialists argue would remedy some of the problems enumerated in the current study. "In the end, if we are going to address the issues raised by Singh et al., we really do not have a choice but to implement a new model of coordinated care," they write.

Singh H, Thomas EJ, Petersen LA, et al. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007;167: 2030-2036.